This spring, 2020, the Supreme Court decided in favor of enforcing Obamacare's federal government risk corridor payments to insurance companies that lost money on Obamacare exchanges during the years 2014-2016. While the decision "upholds" what Obamacare states regarding such temporary payoffs to insurance companies created under the law to essentially give insurance companies incentives to join the exchanges in 2014-'16 by guaranteeing they wouldn't "lose" money, the decision is essentially meaningless for consumers and even for insurers moving forward.
For consumers, we've seen the Supreme Court bend over backwards to preserve the law, which currently seems "popular" in the face of the defeat of Sanders and Warren and their Medicare for all discussion and as Joe Biden imagines the glories of Obamacare.
Short of other reasonable fixes to the outrageous consumer costs of our health industrial complex, even those in the current administration seem to be trying to work with Obamacare.
Lest we completely forget reality, the Maine Community Health Options decision should remind us that above all Obamacare was a deal, a partnership entered into between the federal government and insurance companies that not only used the force of government to lower the bar of coverage into some cheap fix preventive care guarantees of services that nationalized crummy coverage and that also justified insurers reducing coverage for needed medical care and services, but made the federal government a tool in forcing people to purchase health insurance through the individual mandate.
The Maine Community Health Options decision isn't a bad decision on its face because it simply holds that federal payoffs to insurers promised by Obama's Administration through 2016 for insurance companies that participated on exchanges and lost money should be upheld as per the ACA, the Affordable Care Act.
In this instance, the Supreme Court upheld the payments owed to insurers for the years 2014 to 2016 that participated on exchanges and lost money as the temporary provisions of the ACA regarding such payments described.
But the decision presents some tremendous warnings for consumers moving forward.
The Affordable Care Act Section 1342 provides “ESTABLISHMENT OF RISK CORRIDORS FOR PLANS IN INDIVIDUAL AND SMALL GROUP MARKETS…The Secretary shall establish and administer a program of risk corridors for calendar years 2014, 2015 and 2016,” to limit overall LOSSES AND GAINS that an insurance company has and certain LOSSES are paid by the government, HHS (CMS).
First, the original provision of risk corridors and payments by the federal government to insurance companies to incentivize their participation were TEMPORARY, not an ongoing payoff for insurance companies. We already survived year 2017 when insurers pulled out of the exchanges with the expiry of these payoffs. With Joe Biden at the helm of the Democratic Party, consumers should be wary of any ideas of resurrecting the taxpayer expense of paying off insurance companies that lose money on exchanges either as a temporary additional payoff or an indefinite arrangement of paying off insurers simply to keep them participating on exchanges.
In this context, consumers must also remember that enrollment in exchange plans has NEVER met anticipated numbers and has never really exceeded 11 million for any benefits year. Talking about Obamacare as some national option for uninsured Americans is inaccurate UNLESS we're talking about the expanded Medicaid aspects of Obamacare, not the exchange plans because exchange plans are ONLY available for individuals with INCOME that falls within certain guidelines.
Second, we must remember that though in the Maine Community Health Options decision relies on actual wording of the Affordable Care Act in order to pay insurance companies, that the Supreme Court has not shown such loyalty to the actual text of the ACA in other instances, specifically in King v. Burwell, re premium assistance payments and cost sharing specifically available for STATE established exchanges in the Act, or in addressing the legitimacy of the individual mandate and the shaky distinction between fine and penalty in order to uphold that.
Many states have enacted their own individual mandate style provisions which again, work for insurance companies, guaranteeing them customers BY LAW.
Finally, the persistence of Obamacare is in part an indictment of all lawmakers who having protected their own rich benefits ALWAYS look to cut corners on what our tax dollars buy us, break the deal and promises of our continued taxation for Medicare and Social Security,because after all, their benefits are never at stake. This is the real challenge for voting consumers because all politicians come down on the side of saving government money by essentially screwing the rest of us and that's why blatant Obamacare problems such as the family glitch persist to this moment under Obamacare.
The decision in favor of paying insurance companies that participated in exchanges from 2014 to 2016 only with the guarantee of federal reimbursement for their losses is NOT a consumer win, it's an insurance company win and no surprise under Obamacare, the law that codified a partnership between the federal government and insurance companies.
